Practice Guidelines

Pharmacologic Treatment of Hypertension: ACP and AAFP Release Recommendations for Adults 60 Years and Older


Key Points for Practice

• In persons older than 60 years with a persistent systolic BP level of 150 mm Hg or greater, treatment should be aimed at attaining a level of less than 150 mm Hg.

• Starting or increasing BP medications should be considered in older persons with a history of stroke or TIA to achieve a systolic BP of less than 140 mm Hg and reduce the risk of recurrent stroke.

• To lower the risk of stroke or cardiac events, starting or increasing medications should be considered to obtain a systolic BP level less than 140 mm Hg in some older persons with high cardiovascular risk.

From the AFP Editors

Hypertension is a common chronic condition occurring in almost 65% of persons older than 60 years. Proper treatment can lower the risk of cardiovascular, renal, and cerebrovascular disease, as well as mortality; however, there is debate regarding ideal blood pressure (BP) targets. Comorbid conditions should also be considered when choosing a BP target in persons 60 years and older. The American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) have made recommendations for all clinicians to treat hypertension in this patient population, based on the benefits and harms of higher (less than 150 mm Hg) and lower (140 mm Hg or less) systolic BP targets.

Higher vs. Lower BP Targets


Although trials have shown that treating high BP in older persons is beneficial, the evidence was based primarily on persons with moderate or severe hypertension (BP greater than 160 mm Hg) initially who later reached levels greater than 140 mm Hg with treatment. Based on high-quality evidence, all-cause mortality, stroke, and cardiac events are reduced in persons with initial BP levels of at least 160 mm Hg who later attained BP levels lower than 150 mm Hg.

High-quality evidence from a subgroup analysis evaluating trials of persons attaining BP levels less than 140 mm Hg vs. levels of 140 mm Hg or greater indicated that the risk reduction was comparable

Author disclosure: No relevant financial affiliations.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of Practice Guidelines published in AFP is available at



Copyright © 2017 by the American Academy of Family Physicians.
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May 15, 2018

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